The natural history of chronic pain in the community: a better prognosis than in the clinic?

OBJECTIVE: To evaluate the predictors of improvement at 2
years in subjects with chronic widespread pain ascertained
from a community survey.

METHODS: As part of a community
based epidemiological survey on the occurrence of pain, 141
subjects (age range 24-74 years; 44 men, 97 women) were
selected for more detailed assessment. Followup information
on pain experience was collected at a median of 27 months
(range 15-35). Subjects were categorized according to whether
they had no pain, chronic widespread pain (according to the
American College of Rheumatology criteria), or regional pain,
both at initial assessment and followup. In addition,
subjects were examined at both time periods for tender
points.

RESULTS: Of those with chronic widespread pain at
initial assessment, 35% still had chronic widespread pain at
followup, 50% regional pain, and 15% no pain. Of those
originally with regional pain, 65% still had regional pain,
19% chronic widespread pain, and 16% no pain at followup.
Logistic regression analysis was conducted to examine factors
among those with chronic widespread pain associated with
still having these symptoms at followup. Female sex, older
age, leaving school at a young age, high tender point count,
high levels of fatigue, or additional physical or
psychological symptoms were all associated with symptoms
being less likely to resolve.

CONCLUSION: Chronic widespread
pain in the community has a generally good prognosis.
However, those with additional symptoms associated with the
fibromyalgia syndrome were more likely still to have chronic
widespread pain 2 years later.